Reducing High Dose IV Opioid Analgesia in Emergency Departments
The Challenge
Opioid use disorder and opioid abuse is a growing problem in the United States and is a complex medical-social problem.
While emergency departments are not the source of opioid abuse, some emergency departments have varying opioid clinical practices and prescribing cultures.
In an emergency department in Virginia, physicians often used a highly potent opioid called hydromorphone when alternatives were available.
The reasons were multi-factorial:
Patients with opioid dependence or abuse asked for IV injections of a highly potent opioid (hydromorphone) without an outpatient opioid treatment plan.
Physicians, due to fear of potential retaliation from patients and administration, acquiesced to patient demands.
The local clinical practice defaulted to hydromorphone for severe pain control (irrespective of cause and prior history) despite alternatives being available.
the Solutions
We defined the problem, recognizing that opioids would still be needed by a subset of the patient population.
We engaged stakeholders (nurses, physicians, outpatient providers, and experts in chronic pain) to understand the potential needs of patients who have opioid use disorder, opioid abuse, or acute pain syndromes.
We educated our clinical workforce about alternatives to opioids, outpatient resources for chronic pain patients, and communication tools for patient education.
The administration supported the opioid reduction and education plan.
Clinicians used outpatient resources and social work for patients with opioid use/abuse disorders.
the Results
In six months, IV and IM Dilaudid use was reduced by 89% and sustained for one year.
Outpatient opioid prescriptions were reduced by 22% (not a focus of the project, but an indirect correlation).
To discuss how our ABIG can help your organization deliver better patient outcomes and experience, contact us.
